Optimizing the immediate posttransplant prednisone dose - A prospective randomized trial

Adult recipients of HLA non-identical living-related donor (LRD) kidneys were stratified into low-risk and high-risk groups and randomized to receive high-dose (starting at 1 mg/kg) vs. low-dose (starting at 30 mg/day) prednisone. Patient and graft survival and 1-year creatinine levels for the two groups were identical. The low-dose group had more rejections, only 38% of low-dose patients were rejection-free vs. 65% of high-dose patients (p < 0.05). In part, because of the increased incidence of rejection, the low-dose group had significantly more readmissions (p= 0.04). We conclude that, in LRD transplant recipients, low-dose and highdose prednisone protocols are associated with equivalent graft and patient survival. However, there is an increased incidence of rejection and readmissions with low-dose prednisone.